可吸收倒刺缝线v-loc的运用ppt参考课件

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2、i P, Beran C, Stjepanovic J, et al. V-Loc, a New Wound Closure Device for Peritoneal ClosureIs It Safe? A Comparative Study of Different Deritoneal Closure System. Surg Innov. 2011;18(2):145-1494 | Covidien | 01 August 2024 | ConfidentialV-Loc的安全性新鲜尸体实验VL组腹膜承受的平均拉力显著高于其他四组（P0.05 vs. EHS, EKRS, CGRS;

3、 P0.05）。两组间术后阴道出血发生率（1.7% vs. 2.6%, P0.05）。所有出血均自行缓解，无输血病例，无再次手术患者。两组均无术后肠梗阻、阴道残端裂开、感染等并发症。结论：使用V-Loc具有与使用传统缝线相当的安全性。作者提到：在对比使用1年后，因为使用V-Loc缝合操作更方便，术者全部改为使用V-Loc缝合。Neubauer NL, Schink PJ, Pant A, et al. A comparison of 2 methods of vaginal cuff closure during robotic hysterectomy. Int J Gynaecol Obs

4、tet. 2012 Oct 2. doi: 10.1016/j.ijgo.2012.07.01511 | Covidien | 01 August 2024 | ConfidentialV-Loc的安全性临床前瞻性研究美国单中心前瞻性研究2010年3月至2011年3月，共有210例患者在手术中使用V-Loc进行相关缝合：肾脏部分切除术20例肾盂成形术9例，输尿管修整及再植1例半尿路切除术后膀胱缝合8例根治性膀胱切除术后阴道残端缝合12例膀胱部分切除术1例根治性前列腺切除术152例单纯前列腺切除术2例膀胱阴道瘘修补术3例阴道骶骨固定术1例疝修补术1例Shah HN, Nayyar R, Raja

5、mahanty S, Hemal AK. Prospective evaluation of unidirectional barbed suture for various indications in surgeon-controlled robotic reconstructive urologic surgery: Wake Forest University experience. Int Urol Nephrol. 2012;44(3):775-785.12 | Covidien | 01 August 2024 | ConfidentialV-Loc的安全性临床前瞻性研究平均随访

6、6.8个月（114个月）共有5例（2.38%）发现线体切割组织4例缝合错误2例因操作失误，导致针线分离，但是此前已经缝好的线体未发生松弛、滑脱，缝合组织未发生裂开2例缝错部位，需要退出缝针和缝线无线体松弛、滑脱；无尿漏、结石形成、局部瘘形成、尿路梗阻等并发症短期随访提示，在泌尿科手术重建过程中，使用V-Loc是安全、可行、有效的。Shah HN, Nayyar R, Rajamahanty S, Hemal AK. Prospective evaluation of unidirectional barbed suture for various indications in surgeon-

8、感染率几乎就翻一番。Haley等指出，手术时间超过2小时是外科手术伤口感染的第二位独立危险预测因素（第一位是伤口污染）。Cruse PJ, Foord R. A five-year prospective study of 23,649 surgical wounds. Arch Surg 1973;107(2):206-10.Cruse PJ, Foord R. The epidemiology of wound infection: a 10-year prospective study of 62,939 wounds. Surg Clin North Am 1980;60(1):27-

9、40Haley RW, Culver DH, Morgan WM, et al. Identifying patients at high risk of surgical wound infection. A simple multivariate index of patient susceptibility and wound contamination. Am J Epidemiol 1985;121:206-21515 | Covidien | 01 August 2024 | Confidential时间的意义Culver等发现手术时间、伤口分级、ASA评级是手术伤口感染的三大独立

10、预测因素。Procter等总结299,359例手术资料后指出，手术时间不仅是独立的伤口感染预测因素，也是住院时间延长的独立预测因素。Kim MJ等报道，行腔镜泌尿科手术的患者中，较长的麻醉时间与术后肠梗阻相关（P=0.019）。Culver DH, Horan TC, Gaynes RP, et al. Surgical wound infection rates by wound class, operative procedure, and patient risk index. National Nosocomial Infections Surveillance System. Am

11、J Med 1991;19(Suppl 3B):125S-157SProcter LD, Davenport DL, Bernard AC, et al. General surgical operative duration is associated with increased risk-adjusted infectious complication rates and length of hospital stay. J Am Coll Surg. 2010 Jan;210(1):60-65.e1-2Kim MJ, Min GE, Yoo KH, et al. Risk factor

12、s for postoperative ileus after urologic laparoscopic surgery. J Korean Surg Soc. 2011;80(6):384-38916 | Covidien | 01 August 2024 | Confidential时间的意义Evans等报道，行腔镜结肠癌手术的患者中，手术时间与术后并发症（P=0.02）和住院时间（P=0.05）明显相关，手术时间超过180分钟与术后并发症总体发生率的升高有明确的相关性（P=0.006）。Deguchi等统计了1640例胃癌手术患者的资料，多因素分析发现，肺功能障碍（OR 3.300,

13、95%CI 1.620-6.711, P=0.001）和手术时间（OR 1.012, 95%CI 1.007-1.018, P0.001）是吻合口漏的独立预测因素。Agnelli等对2373例恶性肿瘤患者资料分析后发现，手术时间是术后深静脉血栓形成的独立危险因素（OR 4.5, 95%CI 1.1-19.0）Evans C, Lim J, Gatzen C, et al. Factors influencing laparoscopic colorectal operative duration and its effect on clinical outcome. Surg Laparosc

14、 Endosc Percutan Tech. 2012 ;22(5):437-442Deguchi Y, Fukagawa T, Morita S, et al. Identification of risk factors for esophagojejunal anastomotic leakage after gastric surgery. World J Surg. 2012 ;36(7):1617-22Agnelli G, Bolis G, Capussotti L, et al. A clinical outcome-based prospective study on veno

16、13.774.1 vs. 168.675.1 ml P=0.0076AlessandriFerrero随机对照研究RCT2010腹腔镜子宫肌瘤切除44子宫子宫缝合时间缩短11.54.1 vs. 17.43.8 minP0.001术中出血量更少 P=0.004缝合难度更低 P0.001Modi病例系列报道2011腹腔镜子宫肌瘤剜除157子宫使用倒刺缝线明显缩短子宫缝合时间，从而缩短了总的手术时间无相关并发症发生，3月后随访阴道超声，未发现局部血肿及缝合部位肠粘连Gargiulo队列研究2012机器人辅助/腹腔镜子宫肌瘤切除289子宫使用V-Loc使得手术时间缩短195.1 vs. 118.3 m

17、inP0.001术中出血量较少110.0 vs. 85.9 mlP=0.04Nikki病例对照研究2012机器人辅助子宫切除134阴道残端1年后，因操作更方便，主治医师停用传统缝线，全部使用V-Loc术后并发症发生率相当19 | Covidien | 01 August 2024 | ConfidentialV-Loc优势的总结泌尿科作者研究类型发表年份术式病例数缝合部位时间优势其他Sammon随机对照研究RCT2011机器人辅助前列腺癌根治64尿道-膀胱吻合吻合时间缩短10.1 vs. 13.8 minP0.001减少26.8%术后并发症发生率相当传统缝线组发生1例术后尿道血块阻塞Sammo

18、n病例对照研究2011机器人辅助肾脏部分切除30肾脏缝合肾脏热缺血时间缩短 18.55.3 vs. 24.76.6 minP=0.008并发症发生率相当Ashok病例对照研究2012机器人辅助前列腺癌根治50尿道-膀胱吻合吻合时间缩短8.41.7 vs. 14.3 4.8minP=0.0001住院时间缩短1.90.8 vs. 2.71.1days, P=0.023并发症相当Zondervan病例配对研究2012开放/腔镜肾脏部分切除31 pairs肾脏缝合肾脏热缺血时间 19.57.5 vs. 21.89.5 minP=0.312术后并发症减少6.5% vs. 22.6%P=0.038Zorn

19、病例系列报道2011机器人辅助前列腺癌根治30尿道-膀胱吻合术后并发症发生率与以往报道结果相当20 | Covidien | 01 August 2024 | ConfidentialV-Loc优势的总结整形/普外/骨科作者研究类型发表年份术式病例数缝合部位时间优势其他Cruz病例对照研究2012缩乳术20乳房切口缝合总体手术时间缩短4.5h vs. 3.5hP=0.0004两组美容效果相当，都未发生切口裂开等并发症。传统缝线组2例线结排异V-Loc组未发生Blacam病例对照研究2012腹壁下血管皮瓣乳房重建142腹壁切口缝合总手术时间无差异7h 7 min vs. 7h 14minP=0.

20、5459未评估缝合时间差异术后伤口并发症更低 9.9% vs. 23.9%P=0.0423De Blasi病例对照研究2012腹腔镜胃转流100吻合器固有切口缝合缝合时间缩短8.22 2.1 vs. 111.55 minP=0.001随访6个月无吻合口漏无吻合口狭窄作者现常规使用V-LocTakayama病例系列报道2012TAPP16单+3双腹膜缝合手术时间减少较少，但住院医师评价：V-Loc是TAPP手术中理想的腹膜缝合工具11例由住院医师完成手术无术后并发症随访2年，无复发Gililland病例对照研究2012TKA全膝关节置换183皮肤和皮下组织缝合时间缩短19.6 vs. 22.0

21、minP=0.009总体并发症7% vs. 13%P=0.19721 | Covidien | 01 August 2024 | Confidential卢森堡单中心病例对照研究腹腔镜Roun-en-Y胃转流术100例患者纳入研究比较两种不同方法在胃空肠吻合口吻合器固有切口缝合上的差异50例使用V-Loc50例使用传统可吸收缝线De Blasi V, Facy O, Goergen M, et al. Barbed Versus Usual Suture for Closure of the Gastrojejunal Anastomosis in Laparoscopic Gastric B

22、ypass: a Comparative Trial. Obes Surg. 2012 Sep 12. Epub ahead of print22 | Covidien | 01 August 2024 | Confidential卢森堡单中心病例对照研究并发症发生率相当随访6个月，两组病例在基线水平（年龄、BMI、ASA评级、合并症等）方面无明显差异。总手术时间、住院时间、术后并发症等无明显差异V-Loc组（n=50）传统缝线组（n=20）P值手术时间（min）119.2826.29125.0620.320.11住院时间（天）3.20.453.10.30.09吻合口漏00吻合口梗阻00De

23、Blasi V, Facy O, Goergen M, et al. Barbed Versus Usual Suture for Closure of the Gastrojejunal Anastomosis in Laparoscopic Gastric Bypass: a Comparative Trial. Obes Surg. 2012 Sep 12. Epub ahead of print23 | Covidien | 01 August 2024 | Confidential卢森堡单中心病例对照研究更快的吻合速度、更快的学习曲线De Blasi V, Facy O, Goerg

24、en M, et al. Barbed Versus Usual Suture for Closure of the Gastrojejunal Anastomosis in Laparoscopic Gastric Bypass: a Comparative Trial. Obes Surg. 2012 Sep 12. Epub ahead of printP=0.00124 | Covidien | 01 August 2024 | Confidential意大利单中心病例对照研究腹腔镜子宫肌瘤切除术39例患者纳入研究，19例使用V-Loc，20例使用传统可吸收缝线两组患者基线情况（年龄、

25、BMI、肿瘤大小等）无显著性差异Angioli R, Plotti F, Montera R, et al. A new type of absorbable barbed suture for use in laparoscopic myomectomy. Int J Gynaecol Obstet. 2012;117(3):220-22325 | Covidien | 01 August 2024 | Confidential意大利单中心病例对照研究并发症发生率无显著性差异V-Loc组（n=19）传统缝线组（n=20）P值手术时间51.018.1 (35105)58.017.8 (3811

26、0)0.0616子宫切口长度3.20.6 (24)3.40.7 (24)0.5977中转开腹00术中并发症00术后血肿00术后盆腔感染00Angioli R, Plotti F, Montera R, et al. A new type of absorbable barbed suture for use in laparoscopic myomectomy. Int J Gynaecol Obstet. 2012;117(3):220-223两组子宫切口长度相当。V-Loc组手术时间短，但无统计学意义术后并发症等无差异26 | Covidien | 01 August 2024 | Con

27、fidential意大利单中心病例对照研究更短的缝合时间，更少的手术出血Angioli R, Plotti F, Montera R, et al. A new type of absorbable barbed suture for use in laparoscopic myomectomy. Int J Gynaecol Obstet. 2012;117(3):220-223P=0.0004P=0.0176P=0.007627 | Covidien | 01 August 2024 | Confidential意大利单中心随机对照研究腹腔镜子宫肌瘤切除术44例患者，随机分为2组：L组（n

28、=22）：使用V-Loc缝合V组（n=22）：使用传统缝线缝合评估手术时间、缝合时间、术中出血、并发症、子宫缝合难度（VAS法，最难10分，最简单1分）等Alessandri F, Remorgida V, Venturini PL, Ferrero S. Unidirectional barbed suture versus continuous suture with intracorporeal knots in laparoscopic myomectomy: a randomized study. J Minim Invasive Gynecol. 2010;17(6):725-9.

29、28 | Covidien | 01 August 2024 | Confidential意大利单中心随机对照研究术后主要并发症无显著性差异两组病例在基线情况、病史、肿瘤大小、部位等方面无显著性差异总手术时间、主要并发症，两组无显著性差异Alessandri F, Remorgida V, Venturini PL, Ferrero S. Unidirectional barbed suture versus continuous suture with intracorporeal knots in laparoscopic myomectomy: a randomized study. J

30、 Minim Invasive Gynecol. 2010;17(6):725-9.V-Loc组（n=22）传统缝线组（n=22）P值手术时间73.321.4 (63.8-82.8)80.718.6 (72.5-90.0)0.177术前血红蛋白g/dL11.21.2 (10.6-11.7)11.41.2 (10.8-12.0) 0.508中转开腹00主要并发症（如：输尿管、肠管、膀胱损伤）0029 | Covidien | 01 August 2024 | Confidential意大利单中心随机对照研究缩短时间、减少出血、降低难度Alessandri F, Remorgida V, Vent

31、urini PL, Ferrero S. Unidirectional barbed suture versus continuous suture with intracorporeal knots in laparoscopic myomectomy: a randomized study. J Minim Invasive Gynecol. 2010;17(6):725-9.P0.001P=0.004P0.00130 | Covidien | 01 August 2024 | Confidential美国单中心病例对照研究机器人辅助肾脏部分切除术评估2种不同肾脏缝合方法30例患者分为2组

32、：15例使用传统缝线15例使用V-LocSammon J, Petros F, Sukumar S, et al. Barbed suture for renorrhaphy during robot-assisted partial nephrectomy. J Endourol. 2011;25(3):529-23331 | Covidien | 01 August 2024 | Confidential美国单中心病例对照研究两组患者在基线水平、肿瘤大小和部位方面无显著性差异手术总时间、术中出血量、术后并发症方面无显著性差异使用V-Loc可以显著缩短术中肾脏热缺血时间（18.55.3 vs

33、. 24.76.6 min; P=0.008）Sammon J, Petros F, Sukumar S, et al. Barbed suture for renorrhaphy during robot-assisted partial nephrectomy. J Endourol. 2011;25(3):529-233P=0.00832 | Covidien | 01 August 2024 | Confidential美国单中心随机对照临床试验机器人辅助前列腺癌根治术对比使用不同方式行尿道-膀胱吻合的结果比较吻合时间、并发症等64例患者纳入研究，随机分为两组：31例使用传统单股可吸收

34、缝线33例使用V-LocSammon J, Kim TK, Trinh QD, et al. Anastomosis during robot-assisted radical prostatectomy: randomized controlled trial comparing barbed and standard monofilament suture. Urology. 2011;78(3):572-57933 | Covidien | 01 August 2024 | Confidential美国单中心随机对照临床试验并发症发生率无显著性差异两组病例在基线情况、肿瘤分期分级等方面无

35、差异并发症发生率则相当V-Loc组（n=33）传统缝线组（n=31）P值手术时间184 (150231)201 (156226)0.973术后吻合口漏01(3.2%)0.298术后6周并发症1(3.2%)2(6.5%)0.518Sammon J, Kim TK, Trinh QD, et al. Anastomosis during robot-assisted radical prostatectomy: randomized controlled trial comparing barbed and standard monofilament suture. Urology. 2011;7

36、8(3):572-57934 | Covidien | 01 August 2024 | Confidential美国单中心随机对照临床试验缝合时间更短Sammon J, Kim TK, Trinh QD, et al. Anastomosis during robot-assisted radical prostatectomy: randomized controlled trial comparing barbed and standard monofilament suture. Urology. 2011;78(3):572-579P0.001P0.00135 | Covidien

37、| 01 August 2024 | ConfidentialV-Loc可吸收无结缝线36 | Covidien | 01 August 2024 | Confidential评价Closure of the vaginal opening after removal of the cervix became the focus of many innovators, and new suturing devices and techniques were developed. Barbed sutures were perfected, eliminating the need to tie

38、 knots.切除宫颈后的阴道残端缝合成为了众多创新者关注的焦点。涌现出不少新的技术和缝合材料。倒刺缝线因其无需打结，是完美的缝合材料。Nielsen JS. The evolution of minimally invasive gynecologic surgery. Minn Med. 2012;95(3):43-45. 37 | Covidien | 01 August 2024 | Confidential评价为何不要打结？The weakest spot in any surgical suture line is the knot. 缝线上最薄弱之处就在线结上。Surgical

39、knots, when tied too tightly, can cause localized tissue necrosis, reduced fibroblast proliferation, and excessive tissue overlap, all of which lead to reduced strength in the healed wound.线结如果打得过紧，会产生局部组织的坏死，局部成纤维细胞增殖会减少，并致使局部组织过度重叠，从而导致伤口愈合后强度降低。Greenberg JA. The use of barbed sutures in obstetric

40、s and gynecology. J Minim Invasive Gynecol. 2011;18(6):716-719. 38 | Covidien | 01 August 2024 | Confidential评价为何不要打结？A surgical knot represents the highest amount and density of foreign body material in any given suture line. 线结是缝线上异物最多、密度最高之处。Finally, with minimally invasive laparoscopic surgeries

41、, the ability to quickly and properly tie surgical knots has presented a new challenge.在腹腔镜外科手术中，迅速可靠地打结是一个新的挑战。Greenberg JA. The use of barbed sutures in obstetrics and gynecology. J Minim Invasive Gynecol. 2011;18(6):716-719. 39 | Covidien | 01 August 2024 | Confidential评价A knot-secured, smooth su

42、ture creates an uneven distribution of tension across the wound. Although the closed appearance of a wound may be that of equal tension distribution, there are unequal tension burdens placed on the knots. This tension gradient across the wound may subtly interfere with uniform healing and remodeling

43、.传统单股缝线需要打结，其张力在伤口上的分布是不均匀的。尽管看上去张力分布是均匀的，但在线结上的张力却很高。这样出现的伤口张力梯度会敏感地影响伤口的愈合和重塑。Greenberg JA. The use of barbed sutures in obstetrics and gynecology. J Minim Invasive Gynecol. 2011;18(6):716-719. 40 | Covidien | 01 August 2024 | Confidential总结V-Loc的安全性如何？V-Loc能否减少手术操作的时间？V-Loc的时间优势意味着什么？研究证实：V-Loc的安全性良好研究证实，使用V-Loc可以显著缩短手术缝合时间时间就是金钱，时间就是生命41 | Covidien | 01 August 2024 | ConfidentialThank You42 | Covidien | 01 August 2024 | Confidential

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可吸收倒刺缝线v-loc的运用ppt参考课件

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